Intensive Care Medicine | Published: 13 January 2026
Purpose
In critically ill patients, extubation readiness is
typically assessed using a spontaneous breathing trial (SBT). Among patients
with acute brain injury (ABI), the optimal SBT method remains uncertain.
Methods
We conducted a post-hoc analysis of the ENIO study
(NCT03400904), including mechanically ventilated ABI patients with available
SBT data, undergoing extubation attempt. SBTs were classified as T-piece,
pressure support ventilation (PSV), or continuous positive airway pressure
(CPAP). The primary outcome was extubation failure within 5 days.
Associations between SBT modality and extubation failure were assessed using
multivariable logistic regression and inverse probability of treatment
weighting.
Results
Of 1,512 patients enrolled in ENIO, 839 met the inclusion
criteria, of whom 270 (32.2%) were female and 396 (47.2%) had traumatic brain
injury as the cause of admission. SBTs were performed with PSV in 430 (51.3%),
T-piece in 329 (39.2%), and CPAP in 80 (9.5%). SBT median duration was
60 min in PSV and T-piece, while 120 min in CPAP. Extubation failure
occurred in 177 (21.1%) cases. In multivariable analyses, there was no
significant association between SBT modality or duration and extubation outcome.
Results were similar in ABI subgroup analyses. After inverse probability
weighting, vigorous cough remained the only significant predictor of extubation
success.
Conclusions
In this large international ABI cohort, neither SBT mode nor
duration was associated with extubation failure.
No comments:
Post a Comment